Page 216 - Ebook health insurance IC27

The Insurance Times

in the Indian Insurance Industry through certain guidelines for both insurers
and insured, to establish a healthy environment.

To protect the consumer interest, IRDA formed a Policyholder Protection
Regulations, 2002 with a view to safeguarding the interests of policyholders
at large. This comprises a set of guidelines for insurers encompassing the
areas of point of sale, proposal form, grievance redressal, policy details, claims
process and policy servicing.

These guidelines cover the entire policy lifecycle, allowing the insured to make an
informed buying decision and avail ofthepolicy benefits correctly. The act mandates
insurers to provide sufficient information to prospects regarding the aforementioned
areas.

The IRDA has a Grievance Redressal Cell which plays a facilitative role by
taking up complaints against insurers with the respective companies for speedy
resolution. The IRDA however does not adjudicate on complaints.

As claims/policy contracts in dispute, require adjudication and IRDA does not
carry out any adjudication, insured are advised to approach the nearest available
quasi-judicial or judicial channels, i.e, the Insurance Ombudsmen, Consumer
Forums, or the Civil Courts.

(b) Health Insurance for senior citizens and rural/informal sector workers -
IRDA Act empowers it to issue regulations to the insurance companies to cater to
the needs of weaker and vulnerable sections of the society.

IRDA has also designed certain instructions for senior citizens in 2009. It has also

220 Guide for Health Insurance